HESI RN EXIT MEDICAL SURGICAL NURSING NEWEST UPDATED
2025-2026 ACTUAL FINAL EXAM PREP WITH COMPLETE
DETAILED QUESTIONS AND CORRECT CERTIFIED ANSWERS
WITH RATIONALE ALREADY A+ GRADED
Question 1
A client with chronic heart failure is prescribed furosemide (Lasix) 40 mg orally twice daily. The nurse
should prioritize monitoring which laboratory value?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia increases the risk
of digoxin toxicity (if the client takes digoxin) and cardiac dysrhythmias. While sodium, calcium, and
magnesium may be affected, potassium is the most critical to monitor due to cardiac implications.
Question 2
A client with type 1 diabetes mellitus is found unconscious. The nurse should administer which
intervention first?
A) 15 g of oral glucose paste
B) Glucagon 1 mg subcutaneously
C) Orange juice with sugar
D) 50 mL of 50% dextrose IV push
,Correct Answer: D
Rationale: For an unconscious client with suspected hypoglycemia, IV dextrose (D50W) is the fastest way
to restore blood glucose. Glucagon is given if IV access is not available. Oral glucose is contraindicated
because the client cannot swallow and is at risk for aspiration.
Question 3
A nurse is assessing a client with chronic obstructive pulmonary disease (COPD). Which finding requires
immediate intervention?
A) Oxygen saturation of 89% on room air
B) Use of accessory muscles to breathe
C) Productive cough with green sputum
D) New onset of confusion and lethargy
Correct Answer: D
Rationale: New confusion and lethargy in a COPD client may indicate hypercapnia (CO2 retention) or
hypoxemia, which can progress to respiratory failure. This requires immediate assessment and
intervention. An O2 saturation of 89% is below target but not immediately life-threatening in a stable
COPD client (target 88-92%). Accessory muscle use is expected in exacerbations.
Question 4
A client is 6 hours post-abdominal surgery. Which finding should the nurse report to the healthcare
provider immediately?
A) Temperature of 99.2°F (37.3°C)
B) Urine output of 40 mL over the past hour
C) Blood pressure of 90/60 mm Hg with heart rate 110/min
D) Pain rated 6 on a 0-10 scale
,Correct Answer: C
Rationale: Hypotension (90/60) with tachycardia (110) indicates possible hypovolemia or shock
(hemorrhage, dehydration, or sepsis). This requires immediate evaluation. The other findings are within
expected postoperative ranges (low-grade fever, adequate urine output, moderate pain).
Question 5
A client with cirrhosis has ascites and is receiving spironolactone. Which finding indicates the medication
is effective?
A) Decreased abdominal girth
B) Increased serum sodium
C) Weight gain of 2 kg in 24 hours
D) Increased urinary output of 2,500 mL/day
Correct Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic used to treat ascites. Effectiveness is
demonstrated by decreased abdominal girth, weight loss (not gain), and increased urine output. Weight
gain indicates fluid retention. Increased sodium is not a goal.
Question 6
A client with acute pancreatitis reports severe abdominal pain that radiates to the back. Which action
should the nurse take first?
A) Administer prescribed morphine sulfate IV
B) Place the client in a side-lying position with knees flexed
C) Insert a nasogastric tube to low intermittent suction
D) Withhold oral fluids and food
Correct Answer: B
, Rationale: Positioning the client with knees flexed (fetal position) reduces tension on the pancreas and
may relieve pain. While administering morphine is appropriate, positioning is a non-pharmacologic
intervention that can be implemented immediately while preparing medication.
Question 7
A client with chronic kidney disease (CKD) has a serum potassium of 6.2 mEq/L. Which EKG change does
the nurse expect to see?
A) Flat T waves
B) Prominent U waves
C) Tall, peaked T waves
D) Prolonged QT interval
Correct Answer: C
Rationale: Hyperkalemia (K+ >5.0 mEq/L) causes tall, peaked T waves (tenting). Flat T waves and U
waves are seen in hypokalemia. Prolonged QT interval occurs with hypocalcemia or certain medications.
Question 8
A nurse is caring for a client with a chest tube to water seal drainage for a pneumothorax. The nurse
notes continuous bubbling in the water seal chamber. Which action should the nurse take?
A) Clamp the chest tube immediately
B) Assess the system for an air leak
C) Increase the suction pressure
D) Document as an expected finding
Correct Answer: B
2025-2026 ACTUAL FINAL EXAM PREP WITH COMPLETE
DETAILED QUESTIONS AND CORRECT CERTIFIED ANSWERS
WITH RATIONALE ALREADY A+ GRADED
Question 1
A client with chronic heart failure is prescribed furosemide (Lasix) 40 mg orally twice daily. The nurse
should prioritize monitoring which laboratory value?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia increases the risk
of digoxin toxicity (if the client takes digoxin) and cardiac dysrhythmias. While sodium, calcium, and
magnesium may be affected, potassium is the most critical to monitor due to cardiac implications.
Question 2
A client with type 1 diabetes mellitus is found unconscious. The nurse should administer which
intervention first?
A) 15 g of oral glucose paste
B) Glucagon 1 mg subcutaneously
C) Orange juice with sugar
D) 50 mL of 50% dextrose IV push
,Correct Answer: D
Rationale: For an unconscious client with suspected hypoglycemia, IV dextrose (D50W) is the fastest way
to restore blood glucose. Glucagon is given if IV access is not available. Oral glucose is contraindicated
because the client cannot swallow and is at risk for aspiration.
Question 3
A nurse is assessing a client with chronic obstructive pulmonary disease (COPD). Which finding requires
immediate intervention?
A) Oxygen saturation of 89% on room air
B) Use of accessory muscles to breathe
C) Productive cough with green sputum
D) New onset of confusion and lethargy
Correct Answer: D
Rationale: New confusion and lethargy in a COPD client may indicate hypercapnia (CO2 retention) or
hypoxemia, which can progress to respiratory failure. This requires immediate assessment and
intervention. An O2 saturation of 89% is below target but not immediately life-threatening in a stable
COPD client (target 88-92%). Accessory muscle use is expected in exacerbations.
Question 4
A client is 6 hours post-abdominal surgery. Which finding should the nurse report to the healthcare
provider immediately?
A) Temperature of 99.2°F (37.3°C)
B) Urine output of 40 mL over the past hour
C) Blood pressure of 90/60 mm Hg with heart rate 110/min
D) Pain rated 6 on a 0-10 scale
,Correct Answer: C
Rationale: Hypotension (90/60) with tachycardia (110) indicates possible hypovolemia or shock
(hemorrhage, dehydration, or sepsis). This requires immediate evaluation. The other findings are within
expected postoperative ranges (low-grade fever, adequate urine output, moderate pain).
Question 5
A client with cirrhosis has ascites and is receiving spironolactone. Which finding indicates the medication
is effective?
A) Decreased abdominal girth
B) Increased serum sodium
C) Weight gain of 2 kg in 24 hours
D) Increased urinary output of 2,500 mL/day
Correct Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic used to treat ascites. Effectiveness is
demonstrated by decreased abdominal girth, weight loss (not gain), and increased urine output. Weight
gain indicates fluid retention. Increased sodium is not a goal.
Question 6
A client with acute pancreatitis reports severe abdominal pain that radiates to the back. Which action
should the nurse take first?
A) Administer prescribed morphine sulfate IV
B) Place the client in a side-lying position with knees flexed
C) Insert a nasogastric tube to low intermittent suction
D) Withhold oral fluids and food
Correct Answer: B
, Rationale: Positioning the client with knees flexed (fetal position) reduces tension on the pancreas and
may relieve pain. While administering morphine is appropriate, positioning is a non-pharmacologic
intervention that can be implemented immediately while preparing medication.
Question 7
A client with chronic kidney disease (CKD) has a serum potassium of 6.2 mEq/L. Which EKG change does
the nurse expect to see?
A) Flat T waves
B) Prominent U waves
C) Tall, peaked T waves
D) Prolonged QT interval
Correct Answer: C
Rationale: Hyperkalemia (K+ >5.0 mEq/L) causes tall, peaked T waves (tenting). Flat T waves and U
waves are seen in hypokalemia. Prolonged QT interval occurs with hypocalcemia or certain medications.
Question 8
A nurse is caring for a client with a chest tube to water seal drainage for a pneumothorax. The nurse
notes continuous bubbling in the water seal chamber. Which action should the nurse take?
A) Clamp the chest tube immediately
B) Assess the system for an air leak
C) Increase the suction pressure
D) Document as an expected finding
Correct Answer: B
